Choosing Vaginal Birth After Cesarean

If you’ve had a cesarean delivery, you may be able to have a vaginal birth after cesarean, or VBAC, with your next pregnancy. NYU Langone doctors can help determine if you’re a good candidate for VBAC and ensure a safe delivery.

Evidence has shown it may be beneficial to consider a vaginal birth after having had a previous cesarean delivery. Like most women who have vaginal births, women who have VBAC tend to recover faster—four to six weeks compared with six to eight weeks after a cesarean birth. These women also tend to lose less blood during delivery, have a lower risk of infection, and experience less pain during recovery compared with women who've had surgery.

For decades, doctors believed that a woman who had a cesarean birth—in which a doctor delivers a baby through an incision in the lower abdomen—should avoid a vaginal delivery in the future. This is because VBAC has potential complications, including rupture of the uterus, which is when a weakened part of the uterus tears, often at the site of the incision from a prior cesarean delivery.

Today, VBAC is considered to be a safe option for many women who want to try to give birth vaginally. If any complications occur that compromise the baby’s health or blood flow, NYU Langone doctors can perform a repeat cesarean delivery immediately.

VBAC may be unsuccessful if the baby doesn’t descend into the birth canal, or if the cervix does not dilate, or open. If the baby is in the breech position, so that the feet or bottom are likely to be born first, your doctor may also recommend cesarean delivery instead of VBAC.

An NYU Langone obstetrician can help you decide if VBAC is right for you. When doing so, the doctor takes into account the following factors.

Type of Cesarean Delivery Incision

A rare but serious risk associated with VBAC is uterine rupture. This can lead to internal bleeding in the mother. It can also affect blood flow and the supply of oxygen to the baby, potentially causing brain damage or death.

Some women who have a severe uterine rupture may require an emergency hysterectomy, or surgical removal of the uterus. Fortunately, it is very rare for a woman who has chosen VBAC and is delivering a full term baby—one born at 37 weeks of pregnancy or later—to experience this complication.

The type of incision used in a previous cesarean delivery helps your doctor determine whether you’re a good candidate for VBAC. If you’ve had a low-transverse uterine incision, which extends horizontally across the base of the uterus, the risk of rupture is very low compared with women who’ve had a vertical, classical, or T-shaped incision.

Today, surgeons use low-transverse incisions in most women who have full-term babies. A vertical, classical, or T-shaped incision may be made if the baby is positioned unusually or born before full term.

During a cesarean delivery, the surgeon makes two incisions—one in the abdomen and one in the uterus. Because the scar visible on your abdomen may not match the one on your uterus, NYU Langone doctors review your medical records to determine which type of incision was made during a previous delivery.

Number of Previous Cesarean Deliveries

Having a scar on the uterus increases the risk of rupture during labor, because the uterine wall can weaken at the site of any scaring. In general, women who have had one or two cesarean deliveries are considered candidates for VBAC.

Prior Vaginal Delivery

If you’ve had a prior vaginal delivery, your odds of a successful VBAC are increased.

Abdominal Surgery

If you’ve had extensive surgery on your uterus, such as a procedure to remove fibroids, you may not be a candidate for VBAC due to the resulting scars on the uterine wall.

Other Circumstances

If a previous cesarean delivery was due to certain circumstances, such as having twins or a baby in the breech position, you may be a good candidate for VBAC.

However, recurring conditions, such as preeclampsia, which is pregnancy-induced high blood pressure, may prevent you from having VBAC. Preeclampsia increases the chances that an emergency cesarean delivery may be necessary.

In addition, if your child is in a breech position—meaning the baby is positioned to be born with feet or bottom first—your doctor may advise you to have another cesarean birth to avoid trauma to the baby during delivery.

You also may not be a good candidate for VBAC if you've previously experienced a pregnancy complication known as placenta previa, in which the placenta blocks the baby’s exit through the cervix. The condition can recur in subsequent pregnancies.

Other factors that may affect your chances for successful VBAC include being older than age 40, having fewer than 18 months between pregnancies, exceeding 40 weeks of pregnancy, and carrying a baby that is estimated to weigh more than 8 pounds, 13 ounces.

Fetal Ultrasound

Before you go into labor, your doctor may order an abdominal ultrasound, which uses sound waves to create images of your reproductive organs and the baby. Ultrasound can help your doctor determine whether your baby is in the breech position and whether you have placenta previa, which can hinder a vaginal delivery.

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